小儿气管支气管异物368例临床诊治分析

目的:探讨小儿气管及支气管异物的临床特征,提高诊治率.方法:回顾性分析368例气管、支气管异物患儿的临床资料.分析患儿的年龄、性别、病史、异物部位和种类及并发症等.368例患儿中,3例在术前将异物咳出,2例因病情危重未取异物,其他均在全身麻醉下行气管镜检查及异物取出术.结果:3例在术前将异物自行咳出,4例死亡,2例患儿遗留缺氧缺血性脑病、癫痫,余均手术取出异物.结论:对于儿童气管及支气管异物,应详细询问异物吸入史,进行体格检查和胸部X线或CT检查,以避免延误病情和出现误诊、误治.     

成人气管支气管异物43例临床分析

摘要：目的探讨成人气管支气管异物的临床特点及合适的手术方法。方法回顾性分析２０10年１月~２０１5年12月福建医科大学附属龙岩第一医院耳鼻咽喉科收治的成人气管支气管异物43例的诊治过程。根据异物特点,采取合适的手术方式取出气管支气管异物,手术中经麻醉直接喉镜下取出2例、电子支气管镜下取出13例、硬质支气管镜下取出22例、经气管切开处联合硬质支气管镜取出6例。结果43例均成功取出异物,无失败病例,成功率100％,无死亡病例。结论快速有效诊断,术前评估,实施合适的手术方法对成人气管支气管异物的治疗至关重要。     

16例特殊气管异物双径路取出法临床体会

1990年1月~2010年12月,我科共收治气管、支气管异物1950例,其中16例特殊异物经常规硬质气管镜下取出失败而采用双径路取出术,均获成功,现报道如下。1资料与方法16例特殊气管异物患者中男11例,女5例;年龄1~31岁;病程8 h至6个月。异物为义齿2例,珍珠4例,自动铅笔头(小口径)3例,     

2种气管异物1例

患者,女,3岁。因误吸枣肉后呛咳4h,于2010年4月16日以支气管异物急诊收入我院,患儿于4h前食枣时哭闹,当时出现呛咳、面部青紫,约1min后缓解,之后出现刺激性呛咳,到当地医院诊治,未予特殊处理。发病后无意识丧失,无     

气管切开术在儿童呼吸道特殊异物中的应用

目的探讨气管切开术在儿童呼吸道特殊异物取出术中的作用。方法回顾性分析159例儿童呼吸道异物的临床资料,5例（3.14%）经气管切开术取出,其中2例为特殊类型异物。结果 159例儿童呼吸道异物中156例（占98.1%）经硬质支气管镜检查取出异物,1例使用特殊类型导管取出,2例死亡。5例患者行气管切开术取异物（0.63%）,2例为特殊异物。结论当呼吸道异物阻塞较为严重或常规支气管镜检查难以取出的特殊异物时,气管切开术可以迅速缓解呼吸困难,吸出呼吸道分泌物并有助于异物取出。     

气管支气管异物129例临床分析

气管支气管异物是耳鼻咽喉科临床常见急症，是儿童意外伤亡的主要原因之一。为防止并发症，提高救治成功率，笔者总结1992年1月～2004年5月在我院住院治疗、资料完整的129例气管支气管异物患者的临床救治资料，报告如下。     

小儿下呼吸道异物500例临床分析

目的探讨小儿下呼吸道异物手术时机及方法。方法选取我院2005年6月～2009年6月收治的经术后确诊为呼吸道异物且资料齐全的500例患者,就其治疗方面的有关问题进行临床分析。结果纤维支气管镜取出4例（0.8%）;开胸手术取出2例（0.4%）;气管切开从气管切开口导入内镜或硬支气管镜取出20例（4%）;经直达喉镜取出32例（6.4%）;经硬管支气管镜一次完全取出436例（87.2%）,两次完全取尽者6例（1.2%）。结论根据异物种类及存留时间、位置等采取不同的手术方法,以最小的损伤取得最好的治疗效果。     

小儿气管支气管多发性异物求台体会

报告救治３２例小儿气管支气管多发性异物的体会。认为：小儿气管支气管多发性异物有明显增多的趋势，且多为植物性的异物，其临床经过险恶。当围术期出现呼吸道梗阻时，就立即插入支气管镜取异物；迅速建立有效通气道是挽救患儿生命的可靠措施；另外，须常规检查“健侧”支气管，以防止多发笥异物的遗漏。     

纤维支气管镜取气管支气管异物3例

例 1 　 男 ,8岁。误吸塑料哨笛后咳嗽、呼吸不畅 3 d,于 1 997年 1 0月 3 0日入院。体检 :体温3 6 .4℃ ,呼吸 2 0次 /min,呼吸平稳 ,深呼吸时胸腔内发出哨鸣音 ,右肺呼吸音明显减弱。X线胸透 :深呼吸时见纵隔摆动 ,右下肺透光度增强。诊断 :右支气管异物。家属带来与吸入物相同的塑料哨笛一只 ,为白色圆管状 ,长 1 3 mm,一端外径 8mm,另一端略大 ,且有一环形外突的唇缘 ,外径 1 0 .5 mm,管内径 3 .5 mm,内卡有一片可取出的簧片。即取支气管镜及异物钳进行模拟试取 ,哨笛内孔可通过纤维支气管镜活检钳。于当日在全麻下行支气管异物取出术 …     

气管支气管异物527例诊治分析

气管支气管异物是耳鼻咽喉科常见危重急诊之一,我院近15年共有527例收入住院,在无麻或全麻下行直接喉镜、支气管镜异物取出术,取得满意疗效.现报道如下.     

小儿呼吸道异物治疗846例

目的 探讨小儿呼吸道异物的最佳治疗方法。方法 对呼吸道异物患儿846例中的827例,急诊全麻下行支气管镜检查术及异物取出术,感染较重或合并皮下气肿气胸19例患儿先行对症消炎后再行手术。结果 846例中一次手术成功率为99.53%(842/846),4例一般情况不良,行支持消炎治疗后二次手术成功。无1例气管切开、开胸、死亡病例。结论 小儿呼吸道异物的取出要选择最佳的手术时机和麻醉方法,诊治及时,可获得较好疗效。     

Tracheobronchial foreign bodies in infants

Objective

Tracheobronchial foreign body aspiration (FBA) is a common cause of respiratory distress between 1 and 3 years of age. Literature on airway foreign bodies in this age group is abundant; however no study has addressed this problem in infants exclusively. This study aimed to review the clinical presentation, management and outcome of infants with tracheobronchial foreign bodies at a referral tertiary care hospital over a decade.

Methods

102 infants who underwent bronchoscopy for suspected FBA from 1997 to 2007 were retrospectively reviewed. Details of demographic data, clinical features, radiologic and bronchoscopic findings, postbronchoscopy events and eventual outcome were analysed.

Results

The mean age was 10.5 months. 8 (7.8%) were 0-6 months of age, the youngest being 2 months. Males outnumbered (72:30) females. 10 (9.8%) presented secondarily after treatment elsewhere, 6 of them were initially misdiagnosed. The onset-presentation interval ranged from 1 day to 3 months, 41 (40.2%) reporting within a day and 19 (18.6%) a week after onset. 20 (19.6%) had no history suggestive of FBA but harboured airway FBs at bronchoscopy. The clinical triad of cough, respiratory distress and stridor was highly predictive of FBA. 8 (7.84%) had no abnormal physical findings while 8 (10.81%) had grossly normal chest radiographs. All the patients underwent emergency/elective rigid bronchoscopy (Karl Storz system) under general anesthesia as in-patients. The physical findings did not always correlate with radiology or bronchoscopic location of the FB. A peanut cotyledon was the commonest FB retrieved across infancy; in 5 (4.9%) no FB was found/identifiable. 2 required postbronchoscopy mechanical ventilation and 1 a repeat bronchoscopy. There were 6 complications but no mortality in the series. The average hospital stay was 1.4 days. At a week's follow-up, all were asymptomatic and well.

Conclusions

The clinical presentation, diagnosis and management of FBA in 102 infants are presented and certain peculiar features are described. A high index of suspicion coupled with a combination of history, physical signs and radiology is more conclusive than any of them in isolation. Availability of expertise and endoscopic equipment ensures a favourable outcome without significant morbidity and mortality.     

Scarf pins sharp metallic tracheobronchial foreign bodies: presentation and management

OBJECTIVES: Scarf pin inhalation is a cultural hazard in the Middle East young girls. So the aim of this work is to study the presentation of inhaled sharp airway foreign bodies (AFB) and its management. METHODS: Clinical and radiological presentation of inhaled sharp AFB was studied prospectively in 20 young females. All the sharp pins was extracted using rigid bronchoscopes with grasping forceps in 11 and magnetic extractor in 9. RESULTS: The most common presentation after inhalation was penetration syndrome (70%) (sudden onset of chocking and intractable cough). The distribution of AFBs was more significantly in the proximal 90% than the distal (p<0.05). It was significantly more in the left side (65%) than in the right side bronchial tree (5%) (p<0.05). The delay in diagnosis ranged from 6h to 1 week, with no complications on extraction. CONCLUSION: Scarf pins aspiration in females can be mainly presented with penetration syndrome. The site at presentation is mainly in left main bronchus. Early intervention, using rigid bronchoscopes with extraction using grasping forceps or magnetic extractor allowed easy and safe removal. Careful handling of these potentially sharp objects away from the mouth can prevent this critical problem.     

Occult foreign bodies in the aero digestive tracts in infancy

Foreign body impaction in aero digestive tract in infancy is difficult to diagnose sometimes. In this review of five unusual cases of occult foreign body impaction in aero digestive tract has been presented and their management discussed     

成人气管异物临床治疗的回顾性研究

目的：探讨成人气管异物的临床特点、处理经验与教训。方法：总结山东大学齐鲁医院1996年10月至2006年5月间收治的成人气管异物资料30例。结果：异物种类多样,以假牙和植物性异物居多。1例于直达喉镜下取出;3例急症行气管切开术;4例行硬质支气管镜检查+气管切开术;其余22例行硬质支气管镜检查术取出异物。结论：气管异物发生有一定规律性可循,诊询明确的异物吸入史、典型的临床表现及辅助检查多可确诊,根据异物性质及位置选择采取相应手术方法,一般均能治愈。     

特殊类型呼吸道异物的诊断与治疗

目的：探讨特殊类型呼吸道异物的诊断与治疗。方法：分析69例特殊类型呼吸道异物患者的临床资料,其中45例在全身麻醉下经支气管镜通过声门取除异物,24例经气管切开取除异物。结果：经支气管镜取除异物的45例患者中43例治愈,2例在异物通过声门时滑脱,发生异物变位,患者因呼吸衰竭死亡;经气管切开取除异物的24例患者全部治愈。8例术后血氧饱和度低于90％,送到ICU病房经正压通气等治疗后恢复正常,总治愈率为97．1％。结论：特殊类型呼吸道异物可在全身麻醉下经支气管镜通过声门取出;但对年龄较小,有肺不张,异物较大而且形状不规则的患者应通过气管切开取除异物更安全。     

复杂气管、支气管异物4例并文献复习

目的提高复杂气管、支气管异物的诊断与治愈率,减少并发症。方法对我科诊治的4例复杂气管、支气管异物患者资料,结合文献进行回顾性分析。结果2例因异物嵌顿需二次手术,但避免了开胸手术;1例双侧支气管异物因术中即时发现而避免了二次手术,1例上叶支气管异物予部分取出后1个月,自行咳出残余物。结论术前要有充分的准备;纤维支气管镜下异物取出术应用于3岁以上儿童为宜;气管、支气管异物患者是否常规进行CT检查,仍值得探讨;在明确异物情况下,可用力钳取;易脆异物,要注意多发性可能;急诊室应常规备有鳄鱼钳等简单器械,以利迅速取出嵌顿于声门的异物。     

小儿呼吸道异物1276例临床分析

目的：探讨呼吸道异物的有效治疗方案,以降低其并发症和死亡率。方法：分析1276例小儿呼吸道异物患者的麻醉、手术方法及治疗效果。全身麻醉下行支气管镜异物摘取术1275例,单纯喉气管插管未手术1例,并分析3例死亡原因。结果：静脉复合麻醉下支气管镜异物摘取术1197例,1次手术成功取出异物1196例;吸人性乙醚麻醉下支气管镜异物摘取术78例,1次手术成功取出异物65例,2次手术成功取出异物12例。气管切开3例。术后并发喉水肿12例,其中乙醚麻醉者11例,静脉复合麻醉者1例。静脉复合麻醉者最长手术时间达45min,进镜5次,未发生喉水肿;吸入性乙醚麻醉者允许手术时间5-10min,进镜次数最多3次,否则喉水肿严重。窒息死亡3例,死亡率为0．24%。结论：静脉复合麻醉配合咽喉气管黏膜表面麻醉是支气管镜异物摘取术理想的麻醉方法,豆类异物或伴肺不张者危险大,年龄越小危险越大,应高度重视,对有些病例气管切开仍是必要的治疗手段。     

Tracheobronchial foreign bodies

A retrospective review of 88 cases of foreign body aspiration was undertaken. The patients ranged in age from 5 months to 73 years; the peak incidences of foreign body aspiration occurred in children less than 3 years of age and in adults older than 50 years. Sixty-one of the 88 patients were male. Physical examination was abnormal in 61% of patients. The most common radiographic abnormality was inspiratory-expiratory abnormality, seen in 27% of patients. Rigid endoscopy under general anesthesia was the preferred method for removal of the aspirated material. Multiple foreign bodies were found in 5% of the patients. Tracheobronchial foreign bodies should, therefore, be strongly suspected in susceptible patient populations who present with a suggestive history, even when no physical or radiographic evidence can be seen. Patients should be carefully examined for multiple foreign bodies at the time of rigid endoscopic removal.